CDC rape prevention program brings health lens to violence: Funding benefits work in every state

For decades, public health workers have been leading efforts to stop rape and sexual violence before it happens. Today, their successes offer unique insights into creating the conditions that make sexual violence less likely — a topic now at the forefront of national discussions.

“Our role in sexual violence prevention is unique because no other federal agency works to prevent sexual perpetration and victimization before it begins,” Gayle Payne, PhD, branch chief of the Prevention Practice and Translation Branch of the Division of Violence Prevention at the Centers for Disease Control and Prevention, told The Nation’s Health. “Creating safe, stable, nurturing environments and relationships early on in homes, schools and in communities — these are the protective factors for a healthy life moving forward.”

High school students are one audience targeted by projects that are funded through CDC’s Rape Prevention and Education Program, which funds 55 grantees around the nation.

Photo by FatCamera, courtesy iStockphoto

According to data published in 2014 in CDC’s Morbidity and Mortality Weekly Report, nearly 20 percent of women and 1.7 percent of men have been raped in their lifetimes, with most victims first experiencing sexual violence before age 25. Beyond the initial violence and its harms, the consequences of rape have far-reaching health and social impacts. CDC reports that victims of rape experience thousands of unintended pregnancies each year, frequently struggle with chronic psychological problems and often report health-harming behaviors such as drug and alcohol misuse. A study published last year in the American Journal of Preventive Medicine estimated the lifetime cost of rape to society is more than $122,000 per victim.

Guided by a combination of education, engagement and evaluation, CDC’s Rape Prevention and Education Program is working to bring those statistics down. Established in 1994 with passage of the Violence Against Women Act, the program provides funding to all 50 states, Washington, D.C., and a number of territories. Its work zeros in on advancing and integrating primary prevention strategies through a network of collaborative, multi-sector partners. Community partnerships are “how this works gets accomplished,” Payne noted, adding that the program’s 55 grantees report partnering with more than 450 implementing organizations.

Program grantees organize and employ a variety of interventions, including healthy relationship education in schools, youth and college-age bystander training and mentorship programs for young boys that address social attitudes that can normalize sexual violence. For example, one popular strategy is known as Green Dot, which engages entire communities in violence prevention and norm change through activities such as bystander training and raising awareness. According to CDC’s “Stop SV: A Technical Package to Prevention Sexual Violence,” released in 2016, an evaluation of Green Dot among college students found that campuses with the intervention experienced a 19 percent lower rate of sexual harassment and stalking perpetration than campuses without it; high schools using Green Dot reported decreased rates of sexual and dating violence.

As of 2016, across all of CDC’s Rape Prevention and Education grantees, Payne reported 469 unique prevention strategies and more than 1,300 strategy implementations. The program’s current five-year cooperative agreement wraps at the end of 2018, Payne said, and the hope is to begin new agreements in 2019.

“So many of the risk factors for sexual violence are intertwined with risk factors for other health problems,” Payne said. “We see it all being connected.”

While CDC guides the program at the federal level, it is the state health agencies and their community partners that bring prevention to life at the local level.

“Our primary focus is building community connectedness,” Kathleen Palmer, health program manager for sexual violence prevention at the Idaho Department of Health and Welfare, told The Nation’s Health. “If we’re more connected to one another, we’re more likely to recognize that violence is not okay.”

In Idaho, Palmer reported, Green Dot is one of the main strategies taking root, now reaching about 10 high schools, two four-year universities and one community college. The program, which is designed to leverage peer and cultural influences to change social norms, equips young people with the education and skills to become proactive and reactive bystanders. Many of the participating schools have seen success with Green Dot, Palmer said, but it is not always enough to reach the entire student population. In particular, she said community colleges, which serve greater numbers of nontraditional students, wanted interventions better tailored to their environments.

In turn, the state health department, in partnership with North Idaho College and Safe Passage, a local sexual assault and intimate partner violence resource agency, hosted a summit last year with representatives from five northern Idaho counties to identify gaps in existing prevention efforts and develop new strategies. Palmer said the new workgroup will continue meeting, with an ultimate goal of developing evidence-based strategies that can be replicated throughout the state.

Grantees who receive funding via CDC’s Rape Prevention and Education Program conduct outreach on sexual violence prevention in settings such as high schools and colleges.

Photo by Gawrav Sinha, courtesy iStockphoto

At the high school level, Palmer said recent work is focused on keeping Green Dot education fresh and relevant. For example, one of the health department’s partners reported that high school students seemed burned out on the typical Green Dot curriculum, so they introduced new youth empowerment and peer-to-peer exchange components. The result, Palmer said, helped reinforce the Green Dot mission of building strong coalitions of young people committed to violence prevention.

Palmer noted that while “it’s really hard to move the needle on sexual violence,” data from partner schools finds that participating students report higher levels of concern and awareness about sexual violence and feel more confident in their ability to intervene.

“What’s interesting about this work is it’s not just preventing the root causes, but interrupting what can become a generational cycle (of sexual violence),” she said.

To the east in Rhode Island, CDC-supported sexual violence prevention is reaching about 1,500 students in high schools and middle schools each year, according to Sandra Malone, director of prevention and training at Day One, a nonprofit focused on sexual assault that partners with the Rhode Island Department of Health in implementing CDC’s prevention-focused strategy.

A top goal, Malone said, is changing norms and attitudes around healthy relationships. Using a program known as “Your Voice, Your View,” facilitators guide students through a series of discussions on violence misperceptions, boundaries and consent, gender-related issues and how to become an active bystander. The nonprofit is also piloting a new mentorship program for middle-school boys aimed at turning young men into prevention allies.

Malone said students reported positive changes in knowledge and attitudes on sexual violence.

At the college level, CDC funds support the Rhode Island Cross-Campus Learning Collaborative for Sexual Violence Prevention, a group of representatives from 11 colleges and universities that began in 2015 and meets monthly to discuss and swap best practices, said Jolayemi Ilori, MPH, violence and injury prevention project coordinator at the Rhode Island health department.

While the campus collaborative is more focused on learning, Ilori said, the Rhode Island Student Collaborative is focused on action. For example, last April, students organized a “Day of Accountability: Students for Violence Free Campuses,” in which students and college staff raised awareness around sexual violence prevention.

Ilori said she and her partners are working to understand what works best to engage communities on preventing sexual prevention.

“Students want this education,” Ilori told The Nation’s Health. “They want to be part of the solution.”